APPLICATION FORMAT FOR GRANT OF SHORT SERVICE COMMISSION

INTHE INDIAN NAVY FOR EXECUTIVE BRANCH- GENERAL SERVICE/HYDRO CADRE Paste your
recent colour
Last date for receipt of application 30 Mar 2010 photograph
(Do not staple)

1. Name in Block capitals as in Matriculation certificate:-

2. Expanded full name if abbreviated in Serial 2 above:-

3. Father’s Name:-

4. Father’s Occupation/Designation........................................................................................
5. Correspondence Address:-
mnmn
mnm

PIN Mobile: Tele :

EMAIL
6. Permanent Address:-

PIN
7. Priority Cadre: Executive Branch (General Service)/Executive Branch (Hydro Cadre)
a. ________________________
b. ________________________

8. Nationality: 9. State

10. Marital Status: Married o Unmarried o 11. Gender: Male o Female o

12. Date of Birth (DD/MM/YY)
13. Details of Marks Secured in Graduation and above: -
Exam Semester/Year wise Marks secured
Passed
Sem./ Marks Maximum % Marks Sem./ Marks Maximum % Marks
Year obtained marks Year obtained marks
I . V .
II . VI .
III . VII .
IV . VIII .
TOTAL MARKS AND OVERALL PERCENTAGE .
14. Have you attended any SSB interview earlier:-.………... (If yes, give details for all earlier attempts)
Service Navy Army Air Force
Type of Entry
Name of SSB
Month & Year of SSB
Batch No
Rec/ Not Rec
15. Details of Service under Central/State Govt., if any…………………………………………………….
(Candidates already in service should apply through proper channel and obtain NOC from the present employer)

DECLARATION
16. I, hereby, declare that I am unmarried male/ female, governed by nationality condition as laid down by the Government of
India and have never been debarred from appearing at any examination. I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
17. I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
18. I fully understand that in the event of any information being found false or incorrect, action can be taken against me.

Place: …………....…….. Signature...................................................

Date: .......................... Name of the Applicant...................................